Abstract
Background: Esophagogastric junction (EGJ) cancer accounts for 4.2% of all esophageal cancer in Japan, and the outcome of chemoradiotherapy (CRT) for the disease is unclear.Objective: To assess the safety and efficacy of CRT for advanced EGJ squamous cell carcinoma (SCC).Methods: We retrospectively analyzed patients who were treated with definitive CRT for EGJ cancer between September 2002 and September 2013. Patient selection criteria were: pathologically confirmed SCC; clinical Stage IB-III excluding T4 disease (UICC 7th); ECOG performance status (PS), 0-2; preserved organ functions; no previous chemotherapy or radiotherapy; concurrent CRT with 5-FU + platinum and radiation therapy at least 50.0Gy.Results: Nine patients were identified out of 818 who received CRT for esophageal cancer. Patients' background was: Male, 6; the median age, 67 years (range 56-78). PS 0/1/2, 7/1/1. Siewert types I/II/III, 6/3/0; Stage IB/IIA/IIIA/IIIB/IIIC (UICC 7th), 2/2/2/3/0; T 1/2/3, 0/2/7; N 0/1/2/3, 4/2/3/0. As concurrent chemotherapy, 8 patients received CDDP + 5-FU, and 1 received CDGP + 5-FU. The median radiation dose was 60Gy (range 45-60). Eight patients received at least 50Gy of radiation therapy, and 6 patients received 2 cycles of chemotherapy (treatment completion rate was 56%). The reasons for treatment incompletion were: adverse events, 3; and patient's refusal, 1. Complete response rate was 44% (4/9). Common grade 3 or more adverse events were leukopenia, thrombocytopenia, hyponatremia, and esophagitis (33%, in each). No treatment related death was observed. With median follow-up of 8.5 months, the median progression free survival was 9.2 months (95%CI: 5.0-10.5). Disease progressed in 7 patients: regrowth of persistent primary tumor, 2; lymph node recurrence in irradiated field, 1; distant metastasis, 4.Conclusion: It is suggested that CRT for SCC of EGJ associates with higher adverse events and poorer outcome than that for thoracic esophagus.
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